Presentation
Persistent long standing left low back pain.
Patient Data
There is transitional L5 vertebra with a left large transverse process which fuses with the sacrum forming a pseudo-articulation at that location. This could also be called hemi-sacralization of the L5 vertebra.
Grade 1 anterior spondylolisthesis of L4 over L5. Degenerative changes in the spine is noted.
Case Discussion
Bertolotti syndrome is common and affects 4-8% of the population with the classical presentation being chronic lower back pain.
Management includes fluoroscopically-guided steroid injection, radiofrequency ablation and surgical excision of the large transverse process.
This case is in keeping with type IIa LSTV according to Castellvi classification of lumbosacral vertebrae.
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